Predictors of hemorrhage volume and disability after perimesencephalic subarachnoid hemorrhage

A. M. Naidech, N. F. Rosenberg, M. B. Maas, B. R. Bendok, H. H. Batjer, A. J. Nemeth

Research output: Contribution to journalArticlepeer-review

14 Scopus citations


Objective: The determinants of subarachnoid hemorrhage (SAH) volume and an atypical pattern of blood are not clear. Our objective was to determine if reduced platelet activity on admission and abnormal venous drainage are associated with greater SAH volume. Methods: We prospectively identified noncomatose patients with SAH without an identifiable aneurysm. We routinely measured platelet activity on admission and recorded aspirin use. SAH volumes were calculated with a validated technique. CT angiograms were reviewed by a certified neuroradiologist for venous drainage. Patients were followed for clinical outcomes through 3 months with the modified Rankin Scale (mRS). Data are Q1-Q3. Results: There were 31 patients in the cohort. Thirty (97%) underwent an angiogram on admission, and 25 (81%) an additional delayed angiogram. SAH volume was lowest with normal venous drainage bilaterally (4.4 [3.7-16.4] mL) and higher with 1 (12.9 [3.7-20.4]) or 2 (20.9 [12.5- 34.6] mL, p = 0.03) discontinuous venous drainages. Patients with reduced platelet activity had more SAH on the diagnostic CT (17.5 [10.6-20.9] vs 6.1 [2.3-15.3] mL) (p = 0.046). SAH volume was greater for patients requiring drainage for hydrocephalus (16.4 [11.5-20.5] vs 5.4 [2.7-16.4] mL) (p = 0.009). Outcomes at 3 months were generally excellent (median mRS = 0, no symptoms). Conclusions: Discontinuous venous drainage and reduced platelet activity were associated with increased SAH volume and hydrocephalus. These factors may explain thick SAH and reduce the need for repeated invasive imaging in such patients.

Original languageEnglish (US)
Pages (from-to)811-815
Number of pages5
Issue number11
StatePublished - Mar 13 2012

ASJC Scopus subject areas

  • Clinical Neurology


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